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Physicians Give Split Verdict To Consumer Drug Ads

When patients ask physicians about a drug that has been advertised in the general media, their care may improve.

Physicians prescribed a drug advertised directly to consumers 39 percent of the time when patients asked specifically for that drug, according to the results of a survey published on the Web site of the journal Health Affairs. But physicians were just as likely to recommend that patients change their lifestyle to treat a medical condition.

The survey results also showed that such encounters between physicians and their patients led to new treatment for conditions more than half the time, suggesting that while direct-to-consumer advertising (DTCA) may lead to increased drug consumption, it also may have positive effects for patients "that transcend merely prescribing a DTCA drug," the researchers stated.

The survey was conducted by a team of researchers led by Joel Weissman, Ph.D., an associate professor at Harvard Medical School.

Weissman and colleagues asked 643 physicians about how DTCA affected their practices and about the results of their most recent experience in which a patient specifically asked for an advertised drug.

While nearly three-quarters agreed "strongly" or "somewhat" that DTCA helps educate and inform patients about treatments available to them, about 4 out of 5 agreed "strongly" or "somewhat" that DTCA also encourages patients to seek treatment they don't need. More than 4 out of 5 agreed "strongly" or "somewhat" that DTCA does not provide information on risks and benefits in a balanced manner.

Depression and anxiety ranked sixth and seventh, respectively, among the most common conditions for which patients sought a drug that had been advertised directly to consumers. Depression was the condition in 5.8 percent of cases; anxiety was the condition in 5.6 percent of the cases.

The other most common conditions were impotence (10.9 percent of all DTCA-related visits), arthritis (10.5 percent), allergies (9.6 percent), high cholesterol (8.7 percent), heartburn (8.4 percent), pain (3.8 percent), diabetes (3.6 percent), and menopausal symptoms (3.3 percent).

Physicians reported that 25 percent of DTCA-based visits resulted in a new diagnosis; the 10 most common were impotence (15.5 percent of new diagnoses), anxiety (9.0 percent), arthritis (6.8 percent), menopausal symptoms (6.6 percent), allergies (6.0 percent), depression (5.7 percent), hypertension (4.7 percent), pain (4.6 percent), heartburn (4.1 percent), and high cholesterol (3.4 percent).

Physicians prescribed the requested DTCA drug in 39.1 percent of the cases, but were just as likely to recommend a lifestyle change (39.1 percent). Other actions included prescribing another drug (22.4 percent), referring to a specialist (5.8 percent), recommending an over-the-counter drug (12.2 percent), and recommending a diagnostic test (9.3 percent).

In the cases when the DTCA drug was prescribed, 46.1 percent of physicians said it was the most effective drug, while 48.4 percent said that it was as effective as other medications and that they wanted to accommodate their patient's request.

When asked about the impact of prescribing a requested DTCA drug on patients' overall health, 22.6 percent of physicians said it would be a "large positive," and 53.8 percent said it would be "somewhat positive." Few said it would be "somewhat negative" or a "large negative" (1.5 percent).

"When evidence exists on appropriateness, drug advertising may produce a social good by reducing underuse," Weissman wrote. "On the other hand, in different circumstances drug advertising may encourage overuse of higher-cost drugs among patients who have little to gain. Our research provides further insight into the health and health care effects of DTCA, suggesting possible benefits, although it is by no means conclusive."

The survey results are posted online at <http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.219v1?>.

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